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Ask the Expert: New School Year, New Health Advice

Dominique Foulkes, MD Dominique Foulkes, MD
Medical Director of Pediatrics 

The kids are back in school and parents everywhere are rejoicing. In addition to managing a busy schedule of schoolwork, sports, recitals and friends, a new school year can also bring worries about your kids’ health. Dominique Foulkes, MD, medical director of pediatrics, helps make sure you are keeping your kids well throughout the school year.

With cold and flu season coming up, what do you recommend I do to make sure my kids stay healthy?

There are several practical, every day, preventive measures you can take. Staying away from others who are sick and keeping your kids at home when they are sick is very important in limiting the spread of viruses during cold and flu season.

Also, practicing good hand hygiene is one of the most effective ways to keep your family from getting sick. Make sure you encourage your children to wash their hands before eating, after trips to the bathroom and after playing outdoors. Remember that proper hand washing involves wetting hands with water, applying soap, rubbing vigorously for 10 to 15 seconds, rinsing thoroughly and drying with a clean towel.

Advise your children to sneeze or cough into a tissue or onto their sleeves, not into their hands. Soiled tissues should then be immediately discarded. Household cleaning may not be the most pleasant activity, but taking a few minutes each day to clean and disinfect surfaces in the kitchen and bathroom can go a long way towards preventing viral illnesses in your family.

The best protection against influenza, the flu virus, is to have your family immunized.

There have been some safety concerns about immunizations recently. Are vaccines safe?

Almost 20 years ago, a small, now refuted study, raised the question of a possible link between the MMR (measles, mumps and rubella) vaccine and the apparent rise in childhood autism. A few celebrities also vigorously promoted this idea. In 2001 and 2004, an independent panel of experts studied the possibility of a link between the MMR vaccine and autism and found no evidence of such.

Again in 2011, a group of researchers studied the records of almost 100,000 children and found no association between the MMR vaccination and autism spectrum disorders. In 2013, a study by the Center for Disease Control added to the scientific data showing no link between vaccines and autism.

Vaccines are safe and well tolerated with some minor side effects. Serious adverse effects to vaccines are very rare. However, many very serious and potentially life threatening childhood illnesses have been almost eliminated due to the efficacy of vaccines.

I have four kids and one of my daughters has asthma. Should all of them get the flu vaccine or just my daughter?

The American Academy of Pediatrics and the Centers for Disease Control strongly recommends that everyone over six months of age receive the influenza vaccine, including children and adolescents. It is also important that household contacts and other caregivers of children with high risk conditions, such as asthma, and children under the age of five get vaccinated as well.

My son got the flu vaccine last year; does he need it again this year?

Yes. The flu virus is always evolving and it is not unusual for new strains of the virus to appear each year. Because of the ever changing nature of the virus, the composition of the vaccine to protect against it must also be reviewed and updated each year.

My kids got the flu vaccine last year and both got sick after the vaccination. Was it because of the vaccine?

There may be some mild side effects associated with the flu vaccine, the most common of which is pain and tenderness at the injection site. The flu vaccine is not 100% effective so it is possible to get the flu if you’ve been immunized. However, children who get the flu shot tend to have a much milder form of the disease if they do become sick.

My daughter got the nasal vaccine last year. Should she get it again this year?

This year, only the injectable form (flu shot) of the vaccine should be used because the nasal spray was not very effective in the past three flu seasons.

My son has an egg allergy. Can he get the flu shot?

It depends on the severity of your child’s allergy. If the allergy is mild and manifests primarily as hives, he can safely get the vaccine at your pediatrician’s office. If the allergy is more severe and involves difficulty breathing, facial swelling and/or vomiting, then your child should see an allergy specialist before he receives the influenza vaccination.

My pediatrician’s office already has the flu vaccine. Is it too early for my children to get it?

It is best to have your children get the flu vaccine as soon as it becomes available since it takes about two weeks to have full immunity to the virus. This is especially important for children aged six months to eight years who have never received a flu vaccine as they might need two doses separated by four weeks. Even if your children receives the flu shot now, the immunity will last through fall, winter and the early spring.

My family’s morning routine is very hectic and sometimes my kids leave for school without eating. Is breakfast really necessary if I’ve packed them a healthy lunch?

You've probably heard that breakfast is the most important meal of the day. It's true! Research has shown that kids who eat breakfast perform better in school than their peers who routinely skip breakfast. After fasting overnight, the body’s energy stores are depleted and it becomes difficult for children to concentrate and focus in this energy deficient state. Fruit, yogurt, or a whole grain muffin will give your kids the fuel they need.

Keep a variety of easy to grab and go fruit such as apples, bananas, and berries on hand. Healthy whole grain options like toasts, bagels and English muffins and dairy options such as string cheese, fruit and milk smoothies are also easy to serve and prepare when you have limited time.

My 10-year-old daughter is often very tired and cranky at the end of the school day. What can I do to improve her mood?

The most important thing to do is ensure that she is getting enough sleep. Kids between the ages of 7 and 12 need 9 to 12 hours of sleep each night.  After a long day of school, playing with friends, sporting activities and homework, adequate sleep is very important.

Although scientists aren't exactly sure what the brain does during sleep, we know what happens to kids who don't get enough of it. They often find it difficult to control their mood and behavior and may even find it hard to execute simple tasks. More importantly, kids who don't get enough sleep may not grow as well and can become sick more easily.

Kids who sleep the best tend to have a bedtime routine. They might take a warm bath, read a book or drink a warm glass of milk before brushing their teeth. Avoid overly stimulating activities such as exercise right before bedtime.  It is also a good idea to make that your daughter uses her bed only for sleeping. Kids who do homework, play games or talk on the phone in bed can have a harder time falling and staying asleep.

My son is starting high school and is involved in several contact sports. I’m a little worried about long term effects of potential injuries. Any advice for keeping him safe?

The injury with the most potential for long term effects in student athletes is concussion because kids’ developing brains are more susceptible to its effects. While proper protective equipment can mitigate some head injuries, it is important that they are properly managed if/when they occur. The first challenge with managing a concussion is recognizing that it has happened. Coaches, parents and teachers often fail to recognize the signs of concussions. Many high school athletic programs now routinely offer baseline cognitive testing so that after any head injury, possible cognitive deficits can be readily ascertained.

According to the American Academy of Pediatrics’ guidelines, once a concussion is identified, children and adolescents should be evaluated by a physician and receive medical clearance before returning to play. After a concussion, all athletes should be restricted from physical activity until they have no symptoms at rest and with exertion. Symptoms of a concussion usually resolve in 7 to 10 days, but some athletes may take weeks or months to recover. Any athlete who has sustained multiple concussions or who has had a complicated and prolonged concussion recovery should consider refraining from further contact sports.